Gut microbiota biomarkers enable stratified nutritional approaches for functional constipation subtypes in children with comorbidities

Oct 15, 2025Nutrition (Burbank, Los Angeles County, Calif.)

Gut bacteria markers help tailor nutrition for different types of constipation in children with other health issues

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Abstract

Children with functional constipation and comorbidities exhibit distinct gut microbiota alterations, with depleted short-chain fatty acid producers across all subtypes.

Functional constipation subtypes show a significant reduction in short-chain fatty acid-producing bacteria, such as Faecalibacterium and Phascolarctobacterium.
In children with food allergies, Enterococcus levels are higher and negatively associated with the avoidance of animal protein.
Neurodevelopmental disorder-related constipation is characterized by an increase in Blautia and maintained gut diversity.
Children with allergic rhinitis display a decrease in Subdoligranulum and alterations in immune signaling pathways.

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BACKGROUND: Functional constipation (FC) in children with comorbidities (allergic rhinitis [AR], food allergy [FA], neurodevelopmental disorders [DD]) exhibits distinct gut microbiota (GM) alterations, but their implications for comorbidity-tailored nutrition remain unexplored.

METHODS: In this cross-sectional study, 127 children (<6 years) were stratified into: isolated FC (CP, n = 15), FC+AR (CPAR, n = 57), FC + FA (CPFA, n = 30), FC+DD (CPDD, n = 25), and healthy controls (CK, n = 59). Fecal 16S rRNA sequencing (V3-V4) combined with dietary assessment (24-h recall + validated FFQ) identified GM biomarkers and diet-microbe interactions.

RESULTS: All FC subtypes showed depleted short-chain fatty acid (SCFA)-producers (Faecalibacterium, Phascolarctobacterium; log₂ fold change [log₂FC] = -3.2 to -2.3, q < 0.001). Comorbidity-specific signatures were: 1) CPFA: ↑Enterococcus (4.2× versus CPAR, q = 0.009), inversely correlating with animal protein avoidance (Ρ = -0.62, P = 0.01); 2) CPDD: ↑Blautia (log₂FC=1.6, q=0.002) with preserved α-diversity; 3) CPAR: ↓Subdoligranulum (LDA = 4.9, q < 0.0001) and upregulated NOD-like receptor signaling.

CONCLUSION: We propose the first GM-guided framework for stratified nutritional interventions for pediatric FC: 1)Inflammatory subtypes (CPAR/CPFA): SCFA-producers (e.g., Clostridium butyricum) + high-fiber diet + vitamin A fortification (500μg RE/day); 2)Neurodevelopmental FC (CPDD): Gut-brain axis modulators + safety-optimized probiotics; 3)Isolated FC: Fiber-focused dietary optimization.

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Gut microbiota biomarkers enable stratified nutritional approaches for functional constipation subtypes in children with comorbidities

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